Patient Centered Approaches

(21 Nursing Problems)

By: Faye Glenn Abdellah
 Faye Glenn Abdellah’s History:
Dr. Abdellah was born on March 13, 1919 .
She is a pioneer in nursing research who has been recognized with 77
professional and academic honors.
She was the first nurse officer to receive the rank of a two star rear
admiral.
She helped transform nursing theory, nursing care and nursing
education and as a result was inducted into The National Women’s
Hall of fame in 2000.
She is the first nurse and the first woman to serve as Deputy Surgeon
General.
She is a former Chief Nurse Officer for the U.S. Public Health Service,
Department of Health and Human Services, Washington D.C.
She developed educational materials in many key areas of public
health, including AIDS, the mentally handicap, violence, hospice
care, smoking cessation, alcoholism, and drug addiction.
She has been a leader in nursing research and has
150 publications related to nursing education for
advanced practice in nursing and nursing
research.
In 1960, influenced by the desire to promote client
centered comprehensive nursing care, Abdellah
described nursing as a service to individuals, to
families, and therefore to society.
According to her, nursing is based on an art and
science that mould the attitudes, intellectual
competencies, and technical skills of the
individual nurse into the desire and ability to help
people, sick or well, cope with their health needs.
 PHILOSOPHICAL UNDERPINNINGS OF
THE THEORY

Abdellah’s patient-centred approach to nursing was

developed inductively from her practice and is
considered a human needs theory.
The theory was created to assist with nursing
education and is most applicable to the education of
nurses.
Although it was intended to guide care of those in the
hospital, it also has relevance for nursing care in
community settings.
 MAJOR ASSUMPTIONS, CONCEPTS
& RELATIONSHIPS

 The language of Abdellah’s framework is readable and

clear.
 Consistent with the decade in which she was writing,
she uses the term ‘she’ for nurses, ‘he’ for doctors and
patients, and refers to the object of nursing as
‘patient’ rather than client or consumer.
 She referred to Nursing diagnosis during a time when
nurses were taught that diagnosis was not a nurses’
prerogative.
 Assumptions were related to:
– change and anticipated changes that affect nursing;
– The need to appreciate the interconnectedness of
social enterprises and social problems;
 – the impact of problems such as poverty, racism,
pollution, education, and so forth on health care
delivery;
– changing nursing education.
– continuing education for professional nurses.
– development of nursing leaders from under
reserved groups.
Abdellah and colleagues developed a list of 21
nursing problems.
They also identified 10 steps to identify the client’s
problems
11 nursing skills to be used in developing a
treatment typology
 10 STEPS TO IDENTIFY THE CLIENT’S
PROBLEMS
1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data in relation to similar
nursing problems presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make additional
generalizations.
6. Validate the patient’s conclusions about his nursing problems
7. Validate the patient’s conclusions about his nursing problems.
8. Explore the patient’s and family’s reaction to the therapeutic
plan and involve them in the plan.
9. Identify how the nurses feels about the patient’s nursing
problems.
10. Discuss and develop a comprehensive nursing care plan
 11 NURSING SKILLS
1. Observation of health status .
2. Skills of communication
3. Application of knowledge.
4. Teaching of patients and families.
5. Planning and organizing of work.
6. Use of resource materials.
7. Use of personal resources.
8. Problem-solving.
9. Direction of work of others.
10. Therapeutic use of the self.
11. Nursing procedures.
Glenn Abdellah - Twenty-One Nursing Problems

Abdellah's Typology of 21 Nursing Problems are as follows:

1. To promote good hygiene and physical comfort

2. To promote optimal activity, exercise, rest, and sleep
3. To promote safety through prevention of accidents, injury, or other
trauma and through the prevention of the spread of infection
4. To maintain good body mechanics and prevent and
correct deformities
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease
conditions
10. To facilitate the maintenance of regulatory mechanisms and
functions
11.To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and
reactions
13. To identify and accept the interrelatedness of emotions and organic
illness
14. To facilitate the maintenance of effective verbal and nonverbal
communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical,
emotional, and developmental needs
19. To accept the optimum possible goals in light of physical and
emotional limitations
20. To use community resources as an aid in resolving problems arising
from illness
21. To understand the role of social problems as influencing factors in the
cause of illness
 Metaparadigm
Person
 Abdellah describes people as having physical,
emotional, and sociological needs. These needs may
overt, consisting of largely physical needs, or covert,
such as emotional and social needs.
 Patient is described as the only justification for the
existence of nursing.
 Individuals (and families) are the recipients of nursing.
 Health, or achieving of it, is the purpose of nursing
services.
Nursing
 Nursing is a helping profession. In Abdellah’s model, nursing
care is doing something to or for the person or providing
information to the person with the goals of meeting needs,
increasing or restoring self-help ability, or alleviating
impairment.
 Nursing is broadly grouped into the 21 problem areas to guide
care and promote use of nursing judgment.
 She considers nursing to be comprehensive service that is based
on artand science and aims to help people, sick or well, cope
with their health needs.
Health
 In Patient –Centered Approaches to Nursing, Abdellah
describes health as a state mutually exclusive of illness.
 Although Abdellah does not give a definition of health, she
speaks to “total health needs” and “a healthy state of mind and
body” in her description of nursing as a comprehensive service.
Society/Environment
 Society is included in “planning for optimum health on local,
state, national, and international levels”. However, as she
further delineated her ideas, the focus of nursing service is
clearly the individual.
 The environment is the home or community from which
patient comes.
NURSING PROBLEMS
 Nursing problem presented by a client is a condition faced by
the client or client’s family that the nurse through the
performance of professional functions can assist them to
meet . The problem can be either an overt or covert nursing
problem.
 An overt nursing problem is an apparent condition faced by
the patient or family, which the nurse can assist him or them to
meet through the performance of her professional functions.
  The covert nursing problem is a concealed or hidden
condition faced, by the patient or family, which the nurse
can assist him or them to meet through the performance
of her professional functions
 In her attempt to bring nursing practice into its proper
relationship with restorative and preventive measures for
meeting total client needs, she seems to swing the
pendulum to the opposite pole, from the disease
orientation to nursing orientation, while leaving the client
somewhere in the middle.
PROBLEM SOLVING
 The problem solving process involves identifying the
problem, selecting pertinent data, formulating
hypothesis, testing hypothesis through the collection of
data, and revising hypothesis where necessary on the basis
of conclusions obtained from the data.
 ACCEPTANCE BY THE NURSING
COMMUNITY
Practice
– Abdellah’s typology of 21 nursing problems helps nurses
and nursing students perform in a scientific, systematic way.
Education
– Abdellah’s typology of 21 nursing problems had the most
potent effect on the educational system. Educators came to
the realization that revisions are of prime importance if nurses
were to become self-governing.
Research
– The typology of 21 nursing problems was produced through
research; therefore it is expected that more research followed
after its introduction to the academic world.
 USE OF 21 PROBLEMS IN THE
NURSING PROCESS
ASSESSMENT PHASE
NURSING DIAGNOSIS
PLANNING PHASE
IMPLEMENTATION
EVALUATION